HHS Takes Another Step Back From Contraceptive Coverage

WASHINGTON -- The Obama administration is extending an exemption to the Obamacare contraceptive coverage mandate to include closely held for-profit companies and nonprofit organizations whose owners or leaders object to providing the coverage, officials announced.

Under an interim final rule released on Friday by the Department of Health and Human Services (HHS), nonprofit organizations -- such as religiously affiliated universities -- that object to providing contraceptive coverage would inform the federal government of their objection. The government would then reach out to the objecting institution's insurer or third-party administrator, which would provide the coverage free of charge to enrollees of the organization. This rule goes into effect immediately, although the administration is still seeking comments on it.

HHS is also seeking comment on a proposed rule that would extend the exemption to the mandate to closely-held for-profit companies. "Under the proposal, these companies would not have to contract, arrange, pay or refer for contraceptive coverage to which they object on religious grounds," HHS explained in a press release. "The proposal seeks comment on how to define a closely held for-profit company and whether other steps might be appropriate to implement this policy."

However, private businesses whose owners objected to providing contraceptive coverage weren't exempt. One such business, the arts-and-crafts store chain Hobby Lobby, sued over the mandate, and on June 30, the Supreme Court ruled in Hobby Lobby's favor, declaring that the mandate for such companies violated the Religious Freedom Restoration Act of 1993, "which prohibits the 'Government [from] substantially burden[ing] a person's exercise of religion'" unless it shows that doing so is "in furtherance of a compelling governmental interest" and "is the least restrictive means" of doing so.

And although the mandate is still in force for most companies, some women are complaining that their employers are disregarding it and not providing coverage for particular forms of birth control, Kaiser Health News reported.

Moreover, on July 3, which was just a few days after its Hobby Lobby ruling, the Supreme Court granted an emergency injunction to Wheaton College, a Christian school in Illinois that objected to providing coverage for birth control to its employees and students. The injunction allowed the college to delay complying with the contraceptive mandate until its lawsuit on the matter was decided by the courts.

HHS said in its press release Friday that "The rules, which are in response to recent court decisions, balance our commitment to helping ensure women have continued access to coverage for preventive services important to their health, with the Administration's goal of respecting religious beliefs."

Planned Parenthood praised the administration’s action. “The revised accommodation has no impact on for-profit corporations like Hobby Lobby that are now allowed to deny birth control coverage to their employees,” Cecile Richards, president of the Planned Parenthood Action Fund, said in a statement. “Women who work at corporations like Hobby Lobby can still be denied birth control coverage, and we are glad to see that the administration is proposing ways to ensure that these women can get no-copay birth control.”

But not everyone is happy with the new rules. "[They] don't address the real issue -- that still, through the Affordable Care Act (ACA), people are being forced to pay for drugs and devices that can end a human life," said Donna Harrison, MD, executive director of the American Association of Pro-Life Obstetricians & Gynecologists (AAPLOG).

Harrison was referring to the emergency contraceptive Ella and intrauterine devices, which she has noted are capable of killing embryos, either by preventing their implantation or killing them after they have been implanted.

"This accommodation, while it may cause some people to say that it's enough for their consciences ... they still have to pay for these drugs and devices" through their insurance premiums, she continued. "Whether insurer or employer pays, the ACA still has the IUD and Ella being covered because they're labeled as contraceptives. It's a shell game ... I don't think the administration is addressing the real issue."

UPDATE: This article, originally published Aug. 22, 2014, at 6:46 p.m., was updated with new material (Aug. 22, 2014, at 11:00 p.m.).

MedPageToday is a trusted and reliable source for clinical and policy coverage that directly affects the lives and practices of health care professionals.

Physicians and other healthcare professionals may also receive Continuing Medical Education (CME) and Continuing Education (CE) credits at no cost for participating in MedPage Today-hosted educational activities.